An analysis of the evolution of the key indicators of the Spanish health system

This study provides a comprehensive longitudinal analysis of regional health system performance in Spain over the period 2002-2023, using the INCLANS (Indicadores Clave del Sistema Nacional de Salud) framework. The analysis focuses on the evolution of composite indicators capturing key dimensions of health systems with particular attention to regional disparities and temporal dynamics. The empirical strategy combines the construction of metric-based composite indicators with panel data models, convergence analysis, and clustering techniques. The use of a distance-based aggregation framework allows for the development of cardinal and comparable indicators, enabling a consistent assessment of regional performance over time. Sigma and beta convergence measures are employed to examine whether disparities across autonomous communities are narrowing or widening, while clustering methods identify groups of regions with similar temporal trajectories. The results reveal a heterogeneous and multidimensional pattern of regional dynamics. Input-related dimensions, such as health expenditure, human resources, and infrastructure, exhibit persistent divergence, reflecting structural differences across regions within Spain's decentralized health system. In contrast, outcome-related indicators, particularly mortality, display convergence patterns, suggesting a gradual homogenization of health outcomes despite increasing disparities in resource allocation.